A 35 year old white male with no significant past
medical history was transferred from a small rural town in Illinois
to the Regional Burns Unit at the University hospital. The patient
was a farmer’s son and a 20 pack-year smoker. He was involved
in the illicit manufacture of methamphetamine in the basement of his
home. Subsequent explosion resulted in 16 % TBSA burn involving face,
neck and hands, difficulty with breathing and vision.

Before transfer to the
Burns Unit, the patient was intubated in the field by the paramedics,
his eyes were irrigated with water, and a nasogastric tube and an
indwelling urinary catheter was placed. His examination in the Burns
Unit showed conjunctival erythema; lacrimation, thick nasal discharge,
wheezing, throat and second degree skin burns (see Figure 1). His
Laboratory reports were within normal limits. His arterial blood gases
drawn on Assist Control mode of ventilation with a tidal volume of
8 cc/kg. body weight, respiratory rate of 12/minute, peep of 5 and
FiO2 of 40% showed a pH of 7.48 and a PaCO2 of 32 mms. of Hg. and
PaO2 of 70 mms. of Hg. His chest X-ray portable anteroposterior view
is shown in Figure 2.

Patient with facial or oral lesions are at high risk for developing
laryngeal edema
Intubation with a large size endotracheal tube is warranted
Lower airway is affected more than upper airway
Gastrointestinal tract may be affected
Pulmonary edema may be delayed

Question 5:

Which ONE of the following
may NOT be useful in the management of this patient?